An indeterminate result of QuantiFERON-TB Gold In-Tube for miliary tuberculosis due to a high level of IFN-γ production
An indeterminate result of QuantiFERON-TB Gold In-Tube for miliary tuberculosis due to a high level of IFN-γ production
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DOI：
10.1007/s12185-014-1504-3
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发表时间：
2014-04-01
影响因子：
2.1
通讯作者：
Kurokawa, Mineo
中科院分区：
文献类型：
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作者：
Hangai, Sho;Yoshimi, Akihide;Kurokawa, Mineo
QuantiFERON-TB Gold In-Tube(A (R)) 测试对结核分枝杆菌具有出色的特异性。然而，粟粒性结核病的诊断仍然具有挑战性，并且免疫功能低下个体中 QuantiFERON(A(R)) 结果的解释尚未完全确定。在这里，我们介绍了一名军人结核病患者，该患者显示出不确定的 QuantiFERON(A (R)) 结果。一名 76 岁男性出现发烧和全血细胞减少。放射学测试没有显示出经典的粟粒状图案。一些样本的抗酸染色和聚合酶链反应显示结核分枝杆菌呈阴性。 QuantiFERON(A(R)) 反应在两次单独的测试中是不确定的，因为阴性对照中的干扰素-γ (IFN-γ) 浓度较高。该患者对抗微生物治疗没有反应，并出现败血症和弥散性血管内凝血，导致致命的颅内出血。尸检显示粟粒性结核病和再生障碍性贫血。文献综述表明，由于 IFN-γ 产生量低，免疫功能低下的个体或粟粒性结核病患者的 QuantiFERON(A(R)) 结果存在不确定或假阴性的趋势。然而，尽管淋巴细胞减少，我们的患者仍表现出大量的 IFN-γ，这在文献中尚未报道。本病例表明，应谨慎解释 QuantiFERON(A(R)) 的不确定结果，因为粟粒性结核患者的 IFN-γ 产生可能存在显着差异，即使持续淋巴细胞减少也是如此。
The QuantiFERON-TB Gold In-Tube(A (R)) test has excellent specificity for Mycobacterium tuberculosis. However, diagnosis of miliary tuberculosis remains challenging, and the interpretation of QuantiFERON(A (R)) results in immunocompromised individuals has not been fully established. Here, we present a patient with military tuberculosis who showed an indeterminate QuantiFERON(A (R)) result. A 76-year-old male presented with fever and pancytopenia. Radiological tests did not show the classical miliary pattern. Acid-fast staining and polymerase chain reaction of several specimens were negative for M. tuberculosis. The QuantiFERON(A (R)) responses were indeterminate on two separate tests, as interferon-gamma (IFN-gamma) concentration was high in the negative control. The patient did not respond to anti-microbiological therapy, and developed sepsis and disseminated intravascular coagulation, leading to lethal intracranial hemorrhage. An autopsy showed miliary tuberculosis and aplastic anemia. A literature review suggests a tendency towards indeterminate or false-negative QuantiFERON(A (R)) results in immunocompromised individuals or patients with miliary tuberculosis due to low production of IFN-gamma. Our patient, however, showed substantial amounts of IFN-gamma despite lymphocytopenia, which has not been reported in the literature. The present case suggests that indeterminate results of QuantiFERON(A (R)) should be interpreted with caution, as IFN-gamma production in patients with miliary tuberculosis can vary significantly, even with sustained lymphocytopenia.